Provider Demographics
NPI:1134260458
Name:TODD C SNYDER DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TODD C SNYDER DDS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-643-6733
Mailing Address - Street 1:25500 RANCHO NIGUEL RD
Mailing Address - Street 2:# 230
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7302
Mailing Address - Country:US
Mailing Address - Phone:949-643-6733
Mailing Address - Fax:949-643-6731
Practice Address - Street 1:25500 RANCHO NIGUEL RD
Practice Address - Street 2:# 230
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7302
Practice Address - Country:US
Practice Address - Phone:949-643-6733
Practice Address - Fax:949-643-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41870261QD0000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty